<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        <div class="layui-form-item">
            <label class="layui-form-label">代理商名称</label>
            <div class="layui-input-block">
                <input type="text" name="title" class="layui-input" lay-verify="required" placeholder="请输入代理商名称"
                       value="{$row.title|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">代理商电话</label>
            <div class="layui-input-block">
                <input type="text" name="mobile" class="layui-input" lay-verify="required" placeholder="请输入电话"
                       value="{$row.mobile|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label required">身份证正面</label>
            <div class="layui-input-block layuimini-upload">
                <input name="card_z" class="layui-input layui-col-xs6" autocomplete="off" placeholder="请上传身份证正面"
                       value="{$row.card_z|default=''}">
                <div class="layuimini-upload-btn">
                    <span><a class="layui-btn" data-upload="card_z" data-upload-number="one"
                             data-upload-exts="png|jpg|ico|jpeg" data-upload-icon="image"><i class="fa fa-upload"></i> 上传</a></span>
                    <span><a class="layui-btn layui-btn-normal" id="select_card_z" data-upload-select="card_z"
                             data-upload-number="one" data-upload-mimetype="image/*"><i
                            class="fa fa-list"></i> 选择</a></span>
                </div>
                <tip>建议尺寸：350*350</tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label required">身份证反面</label>
            <div class="layui-input-block layuimini-upload">
                <input name="card_f" class="layui-input layui-col-xs6" autocomplete="off" placeholder="请上传身份证反面"
                       value="{$row.card_f|default=''}">
                <div class="layuimini-upload-btn">
                    <span><a class="layui-btn" data-upload="card_f" data-upload-number="one"
                             data-upload-exts="png|jpg|ico|jpeg" data-upload-icon="image"><i class="fa fa-upload"></i> 上传</a></span>
                    <span><a class="layui-btn layui-btn-normal" id="select_card_f" data-upload-select="card_f"
                             data-upload-number="one" data-upload-mimetype="image/*"><i
                            class="fa fa-list"></i> 选择</a></span>
                </div>
                <tip>建议尺寸：350*350</tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">银行名称</label>
            <div class="layui-input-block">
                <input type="text" name="bank_name" class="layui-input" lay-verify="required" placeholder="请输入银行名称"
                       value="{$row.bank_name|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">银行账号</label>
            <div class="layui-input-block">
                <input type="text" name="bank_number" class="layui-input" lay-verify="required" placeholder="请输入银行卡号"
                       value="{$row.bank_number|default=''}">
            </div>
        </div>

        <div class="layui-form-item">
            <label class="layui-form-label">营业执照</label>
            <div class="layui-input-block layuimini-upload">
                <input name="logo" class="layui-input layui-col-xs6" autocomplete="off" placeholder="请上传营业执照"
                       value="{$row.logo|default=''}">
                <div class="layuimini-upload-btn">
                    <span><a class="layui-btn" data-upload="logo" data-upload-number="one"
                             data-upload-exts="png|jpg|ico|jpeg" data-upload-icon="image"><i class="fa fa-upload"></i> 上传</a></span>
                    <span><a class="layui-btn layui-btn-normal" id="select_logo" data-upload-select="logo"
                             data-upload-number="one" data-upload-mimetype="image/*"><i
                            class="fa fa-list"></i> 选择</a></span>
                </div>
                <tip>建议尺寸：350*350</tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">状态</label>
            <div class="layui-input-block">
                {foreach $getStatusList as $k=>$v}
                <input type="radio" name="status" value="{$k}" title="{$v}" {in name="k" value="$row.status"}checked=""{/in}>
                {/foreach}
            </div>
        </div>

        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>
